I thought many of you might find some value in me breaking down what one of my therapy sessions looks like. I will give you an overview of a session I did this past week. The session was with a newly acquired private client who I did a session with at their school with her mother in attendance. It was her second session following her initial assessment which revealed fronting on her /z/ and /s/ sounds, plus misarticulation of the /l/ sound. The 6 year old client was found to be stimulable for all sounds up to the word level. The 20 minute session was timed on my iphone and went as follows:
1. Discuss homework from previous session and get a sense of how it went. If they had trouble maintaining homework schedule we discuss structures to put in place to support their commitment to homework. I ask for only 5 mins a day of homework to be done preferably at the same time in the same place everyday. The idea is to build a habit like brushing the teeth. I am always a stand for homework. In the 10080 minutes available in a week, we need 35 minutes spread across 7 days. It is doable when it is made a priority.
2. /s/ target sound warm-up 40 sets of 5. (200 reps in total) I go fast with these. I push the speed to see if I can get the sound to breakdown then back off to re establish accuracy.
3. /s/ target sound plus vowels AEIOU in the initial and final positions. I do 5 sets of 5. That makes 125 reps for initial targets and 125 reps for final targets. I always go slow for the first set of five then gradually increase the speed keeping the accuracy.
4. Lastly we ventured into double syllable level drills. Here we put 2 syllables together then do one set of 10 for each combination. I tracked these individually to get a percent at the end. This was 100 reps in total. All combinations were 100% except for one which was 90%.
5. Lastly we discussed homework expectation and basically prescribed a scaled down version of what we did during our session. I always send homework home that I know the client can do.
Notice that I did not start at word level drills even though my client is stimulable to word level. In Graduate School I was taught to work on the word level as soon as possible. I have since learned that to not work on phoneme, syllable and double syllable level drills will ultimately slow me down in the end due to carry over into conversation taking far too long.
In the end my client performed 550 reps in this 20 minute session. It has taken me many years to get to the point that I can do this. The big shift came in my relationship to correcting the clients. The bulk of the correcting takes place early on when we are developing consistent stimulability. Once stimulable, the goal of my drillwork with the clients is to get them to progress through the various levels up into conversation while maintaining their accuracy and at the same time pushing their speed. For the most part clients know when they make a mistake and will correct themselves on subsequent trials even when they have not been told. You will only get a chance to witness and appreciate this when doing sets of five rapidly with your client. Because of the speed of the drill you are not able to correct every production. You just need to watch to see if your client is correcting themselves. If they are not correcting themselves and getting entire set of 5 wrong then this is where I intervene and have the client try again slower. This is usually enough to get them back on track. As a clinician, there is no cooler feeling then watching your client motor through sets of five correcting their own errors as they go.
Just recently, it really struck me how little I correct my clients during our sessions compared to when I started. I still do it when absolutely necessary but find if I am correcting them too much, I am working on too high/hard of a level for them. Is anyone a fan of someone constantly correcting them. I am definitely not. As a result of this shift in how I conduct my therapy sessions, they have become much more productive and enjoyable for both me and my clients.
If you are a fellow SLP, feel free to contact me with any questions regarding integrating high repetition therapy into your offerings as a clinician.
Yours in making a difference,